Medical coding and billing are vital to the healthcare industry; healthcare facilities and hospitals request payment for their services. Medical billing services are significant in ensuring that providers get paid for their services. Furthermore, billing and coding services depend massively on the key terminologies in medical billing.
Have you ever thought about what different medical billing terminology means? And then how do these relate to the job at hand?
For this purpose only, we have put together this guide for elaborating on the key terminologies of medical billing.
American Medical Association is a professional association comprising of the following:
It is one of the largest lobbying groups in the USA, and its claim and goal is to improve public healthcare through education and science.
Furthermore, the AMA is particularly important for medical billers and coders as they publish the official list of Physician Specialty Codes. These codes assist medical coders and billers in identifying and labeling treatment and physician specialties. What’s more, the AMA also publishes the CPT (Current Procedural Terminology) code sets, which facilitate outpatient billing and office procedures.
CMS is a US Department of Health entity that serves as an administrative agency in charge of federal healthcare programs. The CMS oversees the state and as well as the federal insurance marketplaces, including:
The accountable care organization is next on the list of key terminologies in medical billing, commonly known as an ACO in the medical billing and coding industry. It is an organization which connects the reimbursements to metrics/standards of quality. The primary goals of accountable care organizations are to reduce the costs per patient and make high-quality care available to patients. The ACOs are also responsible to the patient and third parties, such as the insurance companies that pay for treatments.
ACOs in the USA comprise healthcare professionals who coordinate for connecting payments to the quality of care the Medicare beneficiaries get. Such groups prefer to use alternative methods of payment, like capitation. Capitation is a method of payment where a group of patients pays a fixed amount per unit of time (hourly) spent seeing a healthcare practitioner.
The COB or coordination of benefits entails an instance where two separate insurers work together to pay a claim for a single person. COB is often for:
Number 5 on the key terminologies in medical billing is:
The diagnoses-related groups classify a patient based on the treatment procedures that they receive. The DRG system is designed to contain the costs within the hospitals. Patients get assigned to their respective groups on the variables including:
The FQHCs are qualified healthcare centers offering a wider range of community medical care services. These services include:
All such entities receive federal government grants based on Section 330 of the Public Health Services Act.
The DME or durable medical equipment is any equipment that patients use for maintaining or improving their quality of life. The common types of DMEs include but are not limited to:
Sometimes, these items might be covered by a patient’s insurance.
We Would Love to Assist You!
We treat your data confidentially and don’t share any information with a third party.